Costosternal Anatomy

Anatomy of the thoracic wall.

(Keywords: costosternal anatomy, costo sternal, chest pain, breastbone pain, rib pain treatment)

The costosternal anatomy is unique in the body, and quite diffent to the other bones and joints. This is because of its important function of protection of the vital organs, whilst still enabling breathing. The ribs make up an important part of the thoracic wall.

The ribcage is formed by three sets of bones:

  1. The STERNUM , or breastbone, in front,
  2. which connects via twelve pairs of RIBS to
  3. twelve THORACIC VERTEBRAE posteriorly.

The joints between the breastbone and the ribs are made up of special so-called COSTAL CARTILAGE which may sometimes become very painful in Tietzes syndrome - breastbone pain ...


From the chiropractic perspective, costosternal anatomy is concerned with bones, muscles, joints and nerves. Of course there are also arteries ...

The spaces between the ribs are filled by the INTERCOSTAL MUSCLES. These muscles extends from the sternum to the angle of the rib, posteriorly. They are very important in breathing.

The PECTORALIS MAJOR muscle is can be seen on the anterior thoracic wall. It has two origins, one of which is the sternocostal cartilages and the other the sternum bone.

The PECTORALIS MINOR muscle is located at a deeper level than the pectoralis major muscle. It originates from the third, fourth and fifth ribs and is inserted in the coracoid process of the scapula.

The SERRATUS ANTERIOR muscle covers most of the lateral thoracic wall and originates from the first nine ribs. Its fibers converge posteriorly to be inserted into the medial margin of the scapula, thus contributing towards forming the medial wall of the axilla.

The diminutive SUBCLAVIUS muscle originates from the first rib, close to the chondrocostal junction, to be inserted in the collarbone. Its function is to stabilize the clavicle in movements of the shoulder.

The SERRATUS ANTERIOR muscle covers most of the lateral thoracic wall and originates from the first nine ribs. Its fibers converge posteriorly to be inserted into the medial margin of the scapula, thus contributing towards forming the medial wall of the axilla.

The diminutive SUBCLAVIUS muscle originates from the first rib, close to the chondrocostal junction, to be inserted in the collarbone. Its function is to stabilize the clavicle in movements of the shoulder.

Costo sternal joints: Breastbone Pain

These costosternal anatomy joints, when subluxated, are a common cause of chest pain. Chiropractic treatment involves stretching the doctor's hands right around the ribcage, from the sternum to the spine, an providing gentle thrusts to release the fixations.

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Costo Vertebral Joints

The rib forms three synovial facet articulations with the spine (see below):

  • One with the transverse process, the so called COSTO-TRANSVERSE JOINT, and
  • Two with the vertebral bodies above and below the rib, the so called COSTO-VERTEBRAL JOINTS.

This arrangement restrains the motion of the ribs allowing them to work in a parallel fashion during breathing. If a rib had only one joint posteriorly, the resultant swivel action would allow a rib to move out of sinc with respect to its neighboring ribs, making for a very inefficient respiratory mechanism.

These joints may be sprained, often after a violent sneeze, causing severe sharp pain with every breath. The condition responds extremely well to a gentle chiropractic adjustment.

FROM THE COAL FACE : Iatrogenic Illness

The thoracic spine is usually not the source of serious problems. Irritating, and occasionally acute pain, because of the stabilising ribs, it generally gives much less serious trouble than the neck and lower back. Consequently, it also less x-rayed. Chiropractors generally, myself included will often adjust the thoracic spine without first having given it the attention that one might give the lumbar spine.

Mrs S is a thirtyish woman who had significant Low Back Pain since shortly after the birth of a her first child, about three years ago.

Opinion has it that much low back pain starts during the last trimester of the pregnancy, but in my experience it often starts soon AFTER the birth of the child. All the lifting ... and sometimes within a month of being pregnant.

The lower back pain didn't improve with various other medical ministrations, and six months the pain started radiating down her leg.

She has responded very well, and after a month her low back and leg pain is almost gone.

But ... I adjusted a subluxation between her shoulder blades, where she had no pain, and she is now really suffering! It's a little better, but she's not a happy lady. She came with one pain, and left with another!

That's what we call Iatrogenic Illness, or doctor-caused-disease.


UPDATE: Fortunately with the correct management of her rib the pain soon passed. My point? Rib pain can be caused by an overly zealous manipulation in the mid-back.

For information about chiropractic treatment of rib pain, click here … RIB PAIN TREATMENT

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Costosternal Anatomy - The Breast

The breast obviously lies just adjacent to the costo-sternal joints, and covers some of the muscles.

A breast condition may mimic the costo-sternal syndrome, and occasionally a breast examination by your chiropractor may be indicated. Alternatively, you could ask that your GP do the examination. Talk frankly about it.

During the treatment of the costo-chondral syndrome, the doctor's hands will approximate the breast tissue as s/he firmly adjusts the rib during the in or out phase of breathing. He should release his grip, and slightly remove his hands during the inactive phase of breathing, to ensure that there is no embarrassment.

Should you feel awkward then it may be necessary to ask a friend or family member to accompany you for breastbone pain treatment, or ask if the secretary may be present. It is best to talk frankly about it.

Nerves - costo sternal anatomy

The NERVE bundles from the spine, are threaded between the muscle layers, and are responsible for the innervation of the intercostal muscules.

The pain often radiates along the length of the rib causing flank pain (under the armpit), chest pain mimicing a heart attack if it's on the left side and, if it involves the lower ribs on the right, gallbladder or liver conditions.

As can be seen the costosternal anatomy is unusual in both function and structure, making it vulnerable to various pain syndromes. Other conditions may mimic a rib problem. For example, should you also be experiencing indigestion, a hiatus hernia. INDIGESTION HEARTBURN ...

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Interesting challenges of the day

1. Mr B  came initially for a painful and stiff neck and then asked whether chiropractic could help the cold numb feeling running down the side of his thigh for six months. Meralgia paresthetica is a double crush syndrome with the nerve affected in the back and groin. He's 80% improved after five treatments.

2. Mrs C has a long history of severe, disabling migraine headaches since having her wisdom teeth removed. She clenches her teeth at night. After six treatments she has no migraines but some jaw joint discomfort remains; a bite plate is in the offing.

3. Mrs U has the trophy for the worst back this year. After major surgery with plates and screws two years later she still had paresis in the lower leg and severe disabling back pain. She's doing far better than expected, in no little part due to a lift in her shoe for a very short leg.

4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.

5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.

6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of her foot. It started after a long drive in the car. After six treatments she is 60 percent better, but it's slow and is going to take the full 6 weeks to heal.

And now a setback, after lifting her child she now has leg pain. It's going to the be difficult.

7. This lady is a 70 year old woman, is on maintenance care for a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection after a total shoulder replacement. After four operations he is incapacitated.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. This man is a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. I reassured him it's not hip arthritis.

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mr C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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